Surgical methods and apparatus for bone removal

ABSTRACT

Surgical methods and apparatus for craniotomy flap removal and other delicate bone removal procedures utilizing a core drill driven in such a manner as to give a recognizable indication of near-penetration of the bone surface addressed, thereby preventing injury to highly delicate underlying tissues.

BACKGROUND OF THE DISCLOSURE

The subject invention relates to surgical procedures and apparatus forthe removal of bone. The subject invention is particularly directed tohighly delicate procedures involved in areas such as brain and spinalsurgery. The methods and apparatus according to the inventionconsiderably reduce the risk of paralysis and other serious damagepresently attendant to such procedures.

One procedure where the subject invention finds particular use is in thearea of craniotomy flap removal, a procedure for opening up the skullused in brain surgery. The state of the art flap removal procedureinvolves use of a fluted drill to drill a series of "burr" holes in thecranium at spaced-apart locations around the section of cranium to beremoved. A cutting tool is then inserted to join up the holes. Such aprocedure may take from thirty to forty-five minutes and results inconsiderable loss of bone.

In the current approach to craniotomy flap removal, there is aconsiderable danger of penetration of the dura, a membrane lying betweenthe brain and skull. There is also the risk of penetration of the brainitself. Such damage may result from the considerable plunging pressurewhich must be applied to drills currently in use and the tendency ofsuch drills to "pull through" once they have penetrated completelythrough the skull.

In an attempt to reduce potential injury to the dura or brain, prior artdrills have used a clutching mechanism to disengage the drill uponencountering soft tissue. However, at this point some damage may alreadyhave occurred, and the plunging pressure applied may still propel thedrill into the subcranial matter.

Depth guages have also been suggested to indicate depth of penetrationinto the skull. However, such a device does not eliminate the plungingpropensity of the drill. In addition, the varying thickness of the skullis an obstacle to accurate gauging of penetration. This variance mayrange from 0.080 to 0.30 inches thick.

Another highly delicate surgical procedure where the invention finds useis a procedure known as anterior surgical fusion. In this procedure,sections of bone must be removed from adjacent vertebra. Access to thevertebrae is gained by entry through the neck, which complicates thedrilling approach. Slippage of the drill in such a procedure is anever-present risk and has caused complete and permanent paralysis ofpatients. The present invention makes this process much safer by greatlyreducing, if not entirely eliminating, the risk of accidental slippageor plunging.

SUMMARY OF THE INVENTION

It is therefore an object of the invention to provide an improvedsurgical apparatus and procedure for bone removal.

It is a further object of the invention to lower the risk of seriousinjury attendant to present methods and apparatus for bone removal inareas where drilling error can result in serious physical injury.

Other objects and advantages will be apparent from the ensuingdescription taken with the knowledge of those skilled in the art.

The objects and advantages of the invention are achieved by use of acore drill, such as typically used in the glass cutting arts, drivenwith a high speed, low amplitude oscillation about a central axis. Ithas been discovered that when driven in this manner, the core drillexhibits a selective penetration property--its cutting rate slowsdramatically at a depth near to complete penetration.

It has been discovered that in craniotomy flap removal, for example,such a core drill will circumscribe a desired section of the skull andstop just short of penetration through to the dura at a depth whichpermits the circumscribed bone plug or flap to be easily pried out. Asthe core drill nears penetration of the bone, the bone becomes thin andflexible, and the core drill exhibits the unforeseen property that itpractically stops cutting. This property may be visually sensed byobserving the decrease in flow of cutting debris as the rate of cuttingslows. The procedure may be completed in one to five minutes, dependingon the width of the drill, and leaves a circular bone flap which may bereplaced, resulting in a much faster and cosmetically more desirablehealing.

The drill performs with similar advantage in anterior surgical fusionand permits a replacement bone plug to be cut from the illium to matchthe plug removed from the vertebrae area. The replacement plug may becut more rapidly since a less delicate area is involved.

BRIEF DESCRIPTION OF THE DRAWINGS

The just described invention will now be described in more detail inconjunction with the drawings of which:

FIG. 1 is a perspective view of the apparatus of the preferredembodiment of the invention.

FIG. 2 is a view of the apparatus of the subject invention viewed fromthe cutting face shown out of scale for clarity of illustration.

FIG. 3 is a side view of a human skull illustrating exemplary cranialflaps.

FIG. 4 illustrates a vertebral bone area.

FIG. 5 is another view of the vertebral area of FIG. 5.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The apparatus of the preferred embodiment is shown in FIGS. 1 and 2. Itincludes a diamond or other abrasive-coated core drill 11. This coredrill is preferably a 60 grit although other grits (30-200) may findapplication. The shaft of the core drill 11 is connected to an arm 13.The arm 13 is pivotally connected to a second arm 15 which is pivotallymounted to an eccentric point 18 on a cam 17. The cam 17 is driven by anair or electric motor 19 or other suitable drive means. The motor 19 ispreferably autoclavable.

In operation, the cam 13 and arms 15, 17 convert the rotating motion ofthe drive shaft of motor 19 into a high speed, low amplitude rotationaloscillation imparted to the drill 11. The speed is preferably in therange of 15,000 to 25,000 oscillations per minute (o.p.m.), 20,000o.p.m. having been found to be a preferred choice. The speed is high inthe sense that tool durability will be sacrified at higher speeds. Atlower speeds the cutting rate is decreased. Oscillations in the generalrange of 1,000 to 50,000 (o.p.m.) might be used in variouscircumstances.

Referring to FIG. 1, a housing 21 contains the motor 19 and driveapparatus. The core drill 11 extends out of the housing 19. The housing21 also carries an activation switch 23 and a hose or tube 25 carryingpower (e.g., air or electricity) and water for irrigation. This water isconducted to the cutting area through a channel 27 in the core drill 11.

The degree of peripheral travel imparted to the drill is approximatelyseven degrees for a 1/2 inch core drill. It is desirable to limit totalperipheral linear deplacement to about 0.020 to 0.2 inch withoscillations of about 0.040 to -0.060 inch being preferred in sensitiveareas. Core drills of a diameter out to approximately 21/2 inches and assmall as desired can be used, eliminating in many instances thenecessity to drill more than one hole to complete a surgical procedure.

The procedure according to the invention is to apply the core drill tothe skull or other hard bone area and to activate the tool. Lightpressure on the order of one to 11/2 pounds is required, compared toapproximately 3 pounds required by typical prior art. The drillpenetrates rapidly compared to the prior art, leaving only a powder-likeresidue. The drilling operation is carried out with a flood of water tocool and carry away debris from the cut area. The drill ceases cuttingas the bone section becomes thin enough to be flexible. Cutting debrisceases to flow at this point, providing an indication to the operatorthat penetration is near.

The operator then ceases drilling and pries out the circular bone plugwith an appropriate tool. Because the drill removes so little materialit has been found that the plug may be used to close the opening ifdesired.

FIG. 3 shows typical plugs 29, 31 removed in craniotomy flap removal. Inthe preferred procedure for craniotomy flap removal, after the bone plug29, 31 is removed, surgical procedures within the skull are performed.To close the skull, the plug 29, 31 is replaced and sutured into place.The reuse of the plug provides an improvement in healing time because ofthe very fine cut made and provides a cosmetically more satisfactoryhealing. The core drill 11 itself provides long term durability.

It may be noted that even if the drill of the invention is allowed tototally penetrate the skull, no damage to the underlying tissues willoccur because it will not penetrate soft material. Even surgical glovesare not damaged by contacting the activated drill.

With respect to craniotomy flap removal, the drill of the preferredembodiment also may be rocked or angulated to accomplish cuttingcontoured surfaces and nonuniform thickness areas. Such use, of course,requires the skill of a surgeon familiar with the contours and varyingthicknesses involved.

A 11/2 to 2 inch outside diameter may be used for removal of smallcraniotomy flaps in such procedures as aneurism surgery, posteria fossa,craniotomy and CT guided stereotactic open resection. A 2 to 3 inchoutside diameter is used to remove a standard craniotomy flap forgeneral neurosurgical application including such procedures as tumorresection and emergency hematoma. Drills of 3/8 to 7/8 inch outsidediameter may be used to create standard burr holes in the skull.

The procedure for anterior cervical fusion is illustrated in FIGS. 4 and5. A bone plug 33 is removed from two adjacent vertebra 35, 37 using thecore drill 11. In this procedure it is very difficult to judge the depthof penetration of a conventional drill toward the spinal chord. However,the core drill 11 slows when it reaches the thick casing surrounding thespinal chord, enabling safe operation. In addition, the cut is so cleanthat a bone plug may be cut from the illium with another appropriatelysized core drill to fit the opening 33. Prior art techniques usingrotary curved saws resulted in ragged edges and numerous bone chips. Itmay be noted that when cutting a replacement plug from the illum, thecutting rate of the core drill may be increased over that used insensitive areas by using a coarser grit and increased pressure.

It will be apparent from the foregoing that the invention is applicablein numerous circumstances. Therefore, it is to be understood that,within the scope of the appended claims, the invention may be practicedother than as specifically described herein.

What is claimed is:
 1. A method of removing bone comprising the stepsof:oscillating an abrasive grit core drill with a high speed, lowamplitude drive; placing said drill against the bone, about the bonearea to be removed; drilling into the bone; detecting slowing of cuttingby said core drill as penetration of the bone area is approached andterminating said drilling based upon said detection; and removing thebone plug created by the drilling operation.
 2. The method of claim 1wherein light pressure on the order of one-half that required for afluted drilling operation is applied during the drilling step.
 3. Themethod of claim 1 wherein said step of removing the bone plug includesthe step of prying said plug from the surrounding bone area.
 4. Themethod of claim 1 wherein the bone plug removed is removed from thespinal area.
 5. The method of claim 1 wherein the bone plug is removedin the process of anterior surgical fusion.
 6. The method of claim 1wherein the plug is removed from the cranium.
 7. The method of claim 1wherein the plug is removed from the cranium and reused to close theskull after performance of a surgical procedure.
 8. The method of claim7 wherein light pressure is applied during drilling.
 9. The method ofclaim 1 wherein the speed of oscillation is 15,000 to 25,000oscillations per minute.
 10. The method of claim 1 wherein the bone plugis removed in the process of anterior surgical fusion and a replacementplug is thereafter cut using a second core drill.
 11. The method ofclaim 1 wherein the length of the arc of travel of said core drill is inthe range 0.020 to 0.2 inches.
 12. A method of craniotomy flap removalcomprising the steps of:oscillating an abrasive grit core drill with ahigh speed, low amplitude drive; placing said drill against a portion ofskull to be removed; drilling through at least a portion of the cranium,thereby forming a unitary bone plug; detecting slowing of cutting bysaid core drill as penetration of the bone area is approached andterminating said drilling based upon said detection; removing theunitary bone plug created by the drilling operation; performing asurgical operation through the opening created by removal of the unitarybone plug; and closing the opening by reinserting the unitary bone plug.13. The method of claim 12 wherein said bone plug is removed by pryingit away from the skull.
 14. The method of claim 12 wherein said drill isplaced against the skull with light pressure.
 15. The method of claim 14further including the step of flushing the cutting area with waterduring cutting operations.
 16. The method of claim 12 wherein the speedof oscillation is 15,000 to 25,000 oscillations per minute.
 17. Themethod of claim 16 wherein the linear displacement is within the rangeof 0.020 to 0.2 inches.
 18. The method of claim 12 wherein said drill isapplied to skull portions of varying thicknesses.
 19. The method ofclaim 12 further including a rocking action of the drill to engage theskull.
 20. A method of anterior surgical fusion including the stepsof:oscillating a core drill with a high speed low amplitude drive;applying said core drill to the vertebrae region; detecting slowing ofcutting by said core drill as penetration of the bone area of thevertebrae region is approached and terminating said drilling based uponsaid detection; and removing the bone area to which said core drill isapplied.
 21. The method of claim 20 including the further step ofremoving a replacement plug with an oscillating core drill for insertioninto said vertebrae region.
 22. A method of removing bone comprising thesteps of:oscillating an abrasive grit core drill with a high speed, lowamplitude drive; placing said drill against the bone, about the bonearea to be removed; drilling into the bone; detecting slowing of cuttingby said core drill as completion of penetration of the bone area isapproached and terminating said drilling at that point; and removing thebone plug created by the drilling operation.
 23. The method of claim 22wherein light pressure on the order of one-half that required for afluted drilling operation is employed in the step of drilling.
 24. Themethod of claim 22 wherein said step of removing the bone plug includesthe step of prying said plug from the surrounding bone area.
 25. Themethod of claim 22 wherein the bone plug removed is removed from thespinal area.
 26. The method of claim 22 wherein the bone plug is removedin the process of anterior surgical fusion.
 27. The method of claim 22wherein the plug is removed from the cranium.
 28. The method of claim 22wherein the plug is removed from the cranium and reused to close theskull after performance of a surgical procedure.
 29. The method of claim28 wherein light pressure is applied during drilling.
 30. The method ofclaim 22 wherein the speed of oscillation is 15,000 to 25,000oscillations per minute.
 31. The method of claim 22 or 30 wherein thelength of the arc of travel of said core drill is in the range 0.020 to0.2 inches.
 32. The method of claim 22 wherein the bone plug is removedin the process of anterior surgical fusion and a replacement plug isthereafter cut using a second core drill.
 33. A method of removing bonecomprising the steps of:oscillating an abrasive grit core drill; placingsaid drill against the bone, about the bone area to be removed; drillinginto the bone; detecting slowing of cutting by said core drill ascompletion of penetration of the bone area is approached; terminatingthe drill operation; and removing the bone plug created by the drillingoperation.
 34. The method of claim 33, wherein the length of arc oftravel of said core drill is in the range of 0.020 to 0.2 inches.